Stress and Your Bowel’s Irritation

In this article, Psychologist Mr. Henry Lew introduces us to what Irritable Bowel Syndrome (IBS) is about and the role of psychological intervention in improving the quality of life. Henry practices at Mind Care Therapy Suites, where he helps patients with a broad range of conditions including those with chronic medical and especially gastro-intestinal conditions.  

Life With Irritable Bowel Syndrome (IBS)

Alice* notices pain in her stomach when she was about to leave home. Her stomach has been bloated earlier in the morning. She was hoping the bloating will go away and the pain will not come. As her pain intensifies, Alice wonders if she should cancel her lunch appointment. When Alice thinks about the recommended diet for her health, she felt more discouraged.

Alan* gets back to his work cubicle and restarted working on his project. Less than 15 minutes into his work, he feels a strong churning in his bowels. It was hard to concentrate on his work and Alan had to visit the washroom the 6th time. There was no actual bowel movement. Alan felt helpless and frustrated at the disruption to his work.

Background about IBS

Irritable bowel syndrome  was the medical condition Alice and Alan experienced.

IBS is a gastrointestinal disorder that is fairly common but unfortunately not fully understood. Symptoms include abdominal pain; changes to frequency and consistency of bowel movements (e.g., constipation, diarrhea); excessive wind and bloating of stomach. It occurs in about 10% of the population, across all age group and race, with women being 2 to 3 times more likely to be diagnosed.

Stress and IBS

Stress has been identified to be one of the main contributors to IBS. Stress increases cortisol and impacts the emotional motor system (limbic and paralimbic structures). Stress also impacts immunity. These processes contribute to IBS symptoms.

Living with IBS is stressful. Symptoms hampers individuals’ productivity and functioning. Individuals experience uncertainty, lost and fear, about when IBS will strike and how their lives will be affected. They also experience frustration, loss and sadness over the loss of their lifestyle, diet and physical activities. They are often misunderstood by others as making a mountain out of a molehill, somatizing or malingering. In some cases, symptoms can even can interfere with physical intimacy and affected marital relationships.

IBS is a medical illness – it is not a purely psychiatric illness, nor is it “all in the head”. However, stress and IBS forms a vicious cycle. Stress can trigger gastro-intestinal symptoms, and in turn these symptoms are stressful to manage, which contributes to activation of abdominal symptoms symptoms and a continuation of this cycle. 

Psychiatric/Psychological Treatment & IBS

Given the role of stress in IBS, clinical treatment guidelines recommend psychiatric and psychological interventions to help break the feedback loop between stress and IBS symptoms. Weekly psychotherapy sessions have helped individuals with IBS reduce symptoms of IBS and enhance their everyday functioning and quality of life.

There is a range of psychotherapy for IBS. Cognitive Behavioural Therapy (CBT) and relaxation techniques help individuals manage triggers, thoughts and feelings that contributes to IBS related stress. Acceptance and Commitment Therapy and mindfulness help individuals continue to lead a life driven by what they value, and accept and adapt to the stress and lifestyle changes. Other forms of psychotherapy help individuals deal with related underlying psychological stressors and issues, or problems that arise as a result of IBS symptoms. 

Living with IBS

Alice* and Alan* eventually went for psychotherapy sessions at the recommendations of their doctors. Both realized that they needed more than medication to help them manage their IBS related stress. They also become aware that they needed more help than what they were doing to cope with their lifestyle changes.

Through psychotherapy, Alan identified triggers that contributes to his stress to minimize his IBS flare ups. He manages his thoughts and feelings when he feels stress during an IBS flare. Through psychotherapy, Alice flexibly adapt to the challenges and uncertainty of symptom flare-ups and continues to lead a fulfilling social life. She also finds motivation to make lifestyle behavioural changes to her diet,

Psychotherapy helps individuals continue to lead the life they aspire despite having IBS. Here are some things you can do to cope on your own:

    • Slow down your life
    • Find ways to relax
    • Keep a diary about what causes your IBS flare up
    • Consult your doctor/dietitian on a suitable diet for you

You deserve a better life. As you embark on this journey to reclaim and rebuild your life, we are here for you as you take the first steps.


*Names and situations have been modified

References
Fukudo, S., Okumura, T., Inamori, M., Okuyama, Y., Kanazawa, M., Kamiya, T., … & Koike, K. (2021). Evidence-based clinical practice guidelines for irritable bowel syndrome 2020. Journal of gastroenterology, 1-25.